Melasma refers to darkening of facial skin, most often seen in reproductive-age women, though sometimes in men as well. It typically affects the forehead and cheek areas, but may also be prominent on the chin and mouth. Melasma is not completely understood, but sun exposure and estrogen hormone effects are thought to play a prominent role in its origin. Our understanding of melasma treatment and prevention has evolved significantly over the last decade. Harsh lasers and deep chemical peels are now known to reduce melasma in the short term, often to result in rebound worsened melasma after a few weeks to months. This is thought to be due to the inflammation that such harsh treatments cause. Inflammation is a strong stimulus to darkening or hyperpigmentation in patients with melasma.
At Celebrity Laser Spa, we believe that the foundation of anti-melanin treatment is required to achieve good results with or without the use of laser. This usually entails hydroquinone 4% with or without retin-A. There are alternative bleaching creams, such as Lytera and kojic acid, but it is not clear if these are as effective. For those patients wishing for faster or more profound improvement in melasma, the addition of Q-switched laser treatment may be very helpful. Unlike lasers that burn the skin away, the Q-switched laser works by a “photo-acoustic” effect that results in shattering of pigment granules rather than a thermal burning away. Thus, minimal inflammation along with reduction of pigment can result in rapid improvement of melasma with fewer side effects.
Even Q-switched laser treatment is not without potential side effects. Research has shown that a high number of treatments (at least 9 but typically more) is associated with an uncommon risk of confetti-like bleached skin areas. We therefore recommend not to exceed 9 treatments during a course of treatment for melasma. Most patients receive about 6, each a few weeks apart.
The patient in the photo below had 5 laser treatments for melasma with no side effects and a typical improvement. Continued use of sunblock, excessive sun avoidance, and bleaching cream is required to maintain good results.
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